NPIMap

Organization Active NPI

Wilson Creek Internal Medicine Group

  • Specialist
  • McKinney, TX
National Provider Identifier
1376993337
Registry record updated Jan 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
K9943 Issued in TN
Legal business name
WILSON CREEK INTERNAL MEDICINE GROUP
Practice address
4201 Medical Center Dr Ste 300
McKinney, TX 75069-1777
Phone
(469) 975-8480
Fax
(972) 704-2936
NPI assigned
Jun 20, 2016
Last updated
Jan 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jackie Gwyn Judd
Title
Manager
Phone
(972) 822-5973

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X K9943 TN Primary

Addresses

Primary practice location

4201 Medical Center Dr Ste 300
McKinney, TX 75069-1777

Mailing address

4201 Medical Center Dr Ste 280
McKinney, TX 75069-1767
Phone (972) 562-1018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161214002148 TX Part B Supplier - Clinic/Group Practice 0547540270 Receives reassigned benefits from 10 practitioners
Practice locations: McKinney, TX

National Provider Directory

National Provider Directory

Locations

4201 Medical Center Dr
Ste 280
McKinney, TX 75069
Phone (469) 975-8480

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1376993337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 MEDICAL CENTER DR STE 280",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750691767",
            "telephone_number": "972-562-1018",
            "fax_number": "972-562-1026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 MEDICAL CENTER DR STE 300",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750691777",
            "telephone_number": "469-975-8480",
            "fax_number": "972-704-2936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON CREEK INTERNAL MEDICINE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-20",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A",
        "authorized_official_last_name": "JUDD",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "GWYN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "972-822-5973"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "K9943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McKinney, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.